Exam 4: Depression Flashcards
Major Depressive Disorder Symptoms
change from previous functioning, causes significant distress/dysfunction, 5 of 9 symptoms present for 2 week period: weight gain/loss, insomnia/hypersomnia, psychomotor agitation or retardation, fatigue/energy loss, feelings of worthlessness or excessive/inappropriate guilt, diminished ability to think/concentrate or indecisiveness, recurrent thoughts of death or suicidal ideation/attempt/plan, depressed mood, diminished interest/pleasure
Persistent Depressive Disorder Symptoms
(previously Dysthymic Disorder) chronic (can be mild or major), depressed most of the day more days than not for 2+ years (1 in kids), poor appetite/overeating, insomnia/hypersomnia, low energy/fatigue, low self-esteem, poor concentration or difficulty decision-making, feelings of hopelessnesss; never a manic, mixed, or hypomanic episode; substance abuse is an increased risk
PDD Onset
often begins in early adulthood, sometimes follows a major depression but less common than MDD
MDD Prevalence
19%
MDD High-risk Groups
F2:M1; Poor 3x risk; unrelated to ethnicity or education
MDD Age of Onset
any age, average first episode in 20’s
MDD Course
Single episode: 60% have second
2 episodes: 70% chance of third
3 episodes: 90% chance of fourth
MDD Specifier: Anxious Mood
anxious depression, often with insomnia and agitation
MDD Specifier: Psychotic Features
hallucinations, delusions, or some other break from reality
MDD Specifier: Seasonal Pattern
depression occuring late fall-winter with symptoms disappearing in spring/summer; symptoms as severe as MDD, rarely with anxious mood; not considered chronic
treatment: exposure to light during normal daylight hours to reset original biological sleep/wake cycles
Peripartum Depression
onset: during or after pregnancy; affects around 10% of women but 50% have some symptoms due to dramatic hormone changes, lack of sleep, and lifestyle changes; symptoms of MDD, severe anxiety, panic attacks, possibly psychotic symptoms
Premenstrual Dysphoric Disorder Symptoms
At least 5 symptoms only present during period: 1 of these: irritability/anger/increased conflicts, depressed mood/hopelessness/self-depracating thoughts, anxiety and 1 of these: decreased interest, difficulty concentrating, lethargy, change in appetite, insomnia/hypersomnia, overwhelmed or out of control
Symptoms as severe as MDD & GAD
Occurs for at least 1 year
PMDD Prevalence
1.8-3.8% - not culture bound
PMDD Controversy
said to be pathologizing normal symptoms; there have been 20 years of research but it is still controversial
Culture and Depression
found in every culture, but symptoms are not always the same: doesn’t always present itself as sadness or guilt (nerves, headaches, weakness, fatigue)
Depression in Zimbabwe
depression is 2nd leading cause of disability, possibly more common than US, but there is no term for depression and it is not getting treated or recognized
Depression in Children: Prevalence
< 13: 2%, m=f
13-8 years: 6-8%, f > m
As many as 20% of teens have had depressive episode
Depression in Children: Symptoms
Children can have same symptoms, but usually manifests in irritability and aggression; adolescents present more like adults
Disruptive Mood Dysregulation Disorder
diagnosed in school-aged children over 6; chronic, severe symptoms of irritability and temper outburts out of proportion to the stressor; lasts 1+ year at least 3x a week in more than one setting with irritability most days; alternative to the over-diagnosis of bipolar in children who had no mania, just depression and aggression
Psychodynamic Theory: Freud
early loss or percieved loss, needs not met by parents, early trauma created by hypersensitivity to loss in later years
Psychodynamic Theory: Klerman (Interpersonal Approach)
both past and current relationships interfere with depression (cylical): relationships can cause depression, relationships are affected by depression; based on Bowlby’s Attachment Theory (disrupted attachment bonds can cause depression vulnerability)
Research: Death of a Parent
loss of parent in childhood can increase depression rate; affected by quality of parenting before and after the loss
Japan: loss of same-sex parent causes more severe depression
Learning/Behavioral: Social Reinforcement
reduction in social reinforcement; positive correlation between social rewards and depression
Learning/Behavioral: Learned Helplessness
Seligman’s Dogs: when helpless group was put in a scenario in which they could escape, they did not try to or learned slowly; had symptoms of human depression; external locus of control
Cognitive: Beck (Negative Cognitive Set)
core feature of depression; disturbance in thinking leads to disturbance in mood; tend to be overly critical
Cognitive Pattern: Overgeneralization
generalizing one thing to many other things (this failed, so everything else is going to fail)
Cognitive Pattern: Selective Abstraction
preoccupied with negative details
Cognitive Pattern: Arbitrary Influences
draw conclusions without sufficient evidence
Cognitive Pattern: Magnification/Minimization
magnify mistakes and minimizing achievements when evaluating yourself
Cognitive Pattern: Negative Triad
negative view of self, world, and future
Psychosocial Research: Stress
stressful life events are strongly related to onset of depressin; reciprocal pattern: stress contributes to depression, depression causes stress, people place themselves in riskier situations/relationships which causes more stress
Psychosocial Research: Marital Dissatisfaction
marital distress can lead to depression, and depression does not help a marriage; men are more apt to withdraw from rleationships, women are more likely to become depressed from relationships; good marriages can be protection against depression, especially for men
Psychosocial Research: Family and EE
high EE rates in family can predict a depression relapse
Psychosocial Research: Social Support
helpful in treating depression, does not matter how many people are in network, percieved support helps us to deal with stressors; intimacy (presence of someone close, like sibling, spouse, best friend, etc.) is helpful
Psychosocial Research: Caring for Young Children; Unemployment
both associated with higher rates of depression
Psychosocial Research: Gender/Employment/Marriage Interaction
highest rates: unemployed divorced women
lowest rates: employed married men
widows show no gender differences
Role of Genetics
modest heritability; twin studies: heritability ~37%, higher in inpatient populations (stronger role in severe depression), larger role in females than males, specific gene 5HTT on chromosome 17 (affects serotonin messages)
Neurotransmitters: Early Theory Biogenic Amines
dopamine, norepinephrine, serotonin; originally: low NE = depression/high NE = mania; low 5HT = depression
Neurotransmitters: Early Theory Drug Research
tricyclics: increase NE & 5HT by blocking reuptake
MAOIs: prevent NE & 5HT breakdown
Resperine causing depression: reduced levels of all biogenic amines, created to relieve muscle tension
Neurotransmitters: Early Theory Problems
drugs take 1-2 weeks to relieve symptoms, but effect on neurotransmitters are immediate; increase levels when first taken, but later go back to normal levels
Neurotransmitters: Revised Theory
focus on post synaptic receptor sensitivity and the interactions of biogenic amines and other neurotransmitters
Neurotransmitters: BDNF Research
deficiencies in BDNF (neuron growth chemical): exercise increases BDNF and helps with depression
Neurotransmitters: Animal Research
proves that depressed behavior is not just cognitive
Hormonal Imbalance
malfunction of hypothalamus, pituitary gland, thyroid, and estrogen levels can cause depression; high cortisol levels (also associated with PTSD); dysregulation of hypothalamus/pituitary axis (also associated with child maltreatment/early life stressors)
Sleep Disturbances
suggest a problem with a biological clock
Environmental Factors
past experiences with loss/trauma affect current stressors
